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Sunday, February 25, 2024 | Back issues
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Feds Cleared as to Speech Device Insurance Denial

WASHINGTON (CN) - Uncle Sam need not offer insurance coverage that covers speech-generating devices for government employees, a federal judge ruled.

Speech-generating devices, or SGDs, are medical equipment that communication-impaired people use to communicate.

Douglas Huron, whose wife belongs to a subsidized health benefits program provided by the Government Employees Health Association (GEHA), uses such a device to communicate. When the SGD he obtained through a prior insurer stopped functioning, Huron required a replacement.

GEHA expressly excludes SGDs, however, and Medicare, which also gives Huron benefits, will reimburse Huron for just 80 percent of the cost of a new SGD, which can cost thousands of dollars at the top of the line.

Alongside the U.S. Society for Augmentative and Alternative Communication, Huron sued the Office of Personnel Management and its former director, John Berry, over its coverage exclusion.

U.S. District Judge Amy Jackson tossed the case last week for lack of standing.

"Here, Huron's injury - the inability to obtain an SGD through his wife's GEHA plan - is self-inflicted, and that severs the causal link necessary to establish standing," Jackson wrote.

She added that "the Huron family voluntarily chose to enroll and stay enrolled in a plan that specifically excludes [the devices] from coverage, despite having the option to select and transfer to a plan that covers [them]."

Five of 10 federal health plan sponsors and three of five federal local plan sponsors cover speech-generating devices to some extent, according to the ruling. Of those plans, two offer coverage to all federal workers and three offer plans to only a select group of federal workers.

"All of these plans limit SGD coverage to between $500 and $1250 - limitations that do not apply to other covered items in the durable medical equipment category," Jackson wrote.

The court rejected Huron's argument that the government had arbitrarily excluded SGD coverage.

"The fact remains that the Hurons chose - on their own - to forgo coverage options that would have met Huron's SGD needs because the family decided cost considerations and other family members' healthcare needs came first," Jackson wrote.

Noting that the U.S. Society for Augmentative and Alternative Communication had failed to demonstrate that any of its members have standing to sue in their own right, the judge also denied its bid for standing.

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